Are You Still A Pharmacist?

When I tell people I am a pharmacist many people picture me working behind the counter of a local retail pharmacy working at a computer station while on the phone and maybe counting pills too. Some people consider this to be a cushy job. Retail pharmacy has no real physical demands and a good salary. Heck, another health care professional writes a prescription and the pharmacist reads it and fills it.

This perception is partially true but there is much more to it.

Many patients don't fully understand the amount of interactions that pharmacists perform on a daily basis. I counted myself how many interactions I made in one 40 hour work week, there are as follows: 22 refill too soon interactions (10 were due to patients wanting controlled medications early and 12 due to patients getting refills on medications they did not know how to take properly), 26 drug changes (10 due to drug interactions that could result in serious side effects, 10 due to cost concerns for the patient and 6 to provide more optimal drug therapy) and 11 prescriptions where changed due to dosage/frequency concerns.

These changes did not include issues that insurance companies prompted me to correct. These where changes I made as a pharmacist. These where changes that helped improve health care for my patients.

With all of this contact amongst other professionals including mostly physicians and nurses you would think they would realize what retail pharmacists can do? Realize the importance of having that final set of knowledge, training and eyes brings to the table, right?

Many of them do, then there are stories like this...

My intern came to work one as usual since he is now a a month break in between rotations. After I got done explaining to a nurse why the physician needed to switch medications for a patient, I hung up the phone, turned to my intern and said, "Sometimes I am amazed and that I have to explain myself in such detail to other people in health care."

The intern looks and me and says, "Well, on my last rotation I told a nurse I wanted to do retail. She then asked me if I'd still be a pharmacist. I explained to her yes I would still be a pharmacist, I'd fill prescriptions and make drug interactions and give patients their medications while counseling them too. She didn't get what retail pharmacists do. She honestly thought we just threw pills into a bottle and that was it. She didn't get why I needed a doctorate to dispense medication. She had no idea what pharmacists do or that we actually did anything. I got kinda mad at her and no matter what I said she just had this close minded idea about pharmacists:"

I can almost see a construction worker thinking this. I can almost see a pastor thinking this. I can almost see the normal little old lady (an L.O.L.) thinking this.

I can NOT see a nurse thinking this!

How can another health care professional be so ignorant to what a whole class of medical professional does!

This is the equivalent to me talking to a nurse and saying, "I thought all you did was walk around in scrubs, jot down my blood pressure and gossip with other nurses in the hallway. Any knuckle-dragger can do that, right?"

Now before the nurses I know jump down my throat, I know all that you do. I know you usually double check even my work as a pharmacist, help physicians by describing what the patient has been up to and reacting to, all while taking care of the patients basic needs and address their many concerns. I know you do even more than that. Just like pharmacists do many little things that are in the best interests of their patients that are also too numerous to list.

Just today I had a patient who was very concerned about their mental health. He was a diagnosed manic-depressive who was on Zyprexa and Seroquel but has been getting more depressed recently. I asked him a few questions before getting out of him that he hadn't been on his prescribed Celexa as well. He mentioned that he must have forgot to get it refilled and when asking a few more questions it became apparent that his depression had been increasing for over 4 months, the same time frame he had been off his Celexa. I suggested he refill it then let myself and his physician know how he was doing in a month or so. He was more than thankful for my time and was certain that this would help. Now I can't say if it did or didn't help as it is too soon to tell but by explaining what I knew and understood this man was appreciative and understanding. What else could I do as a pharmacist?

This is why I make sure to do my best to fully explain to everyone what it is I am doing or did for them. This includes physicians, nurses and especially patients. The degree of explanation varies with who I am talking to but nonetheless I still explain. I feel this helps instill confidence in both myself and my profession. Every pharmacist should do the same to the best of their ability. It is part of the reason pharmacists were the #1 trusted profession for so many years. As the most accessible health care professional it is part of our duties. It is what will help patients and other professionals recognize the importance of our role and realize that we are not simply robots dispensing medications. We are needed professionals who bring a different perspective and knowledge base that can help ensure optimal medical treatments as well as keep costs down. Good pharmacists are always in need even if we are in retail we can still make a big difference, as much as any other health care professional. Without us patients wouldn't get their medications, there would be more medication errors and the health care system would be far worse than it is even now.

This is why I am a pharmacist!

Sorry!

Sorry I haven't posted lately! Been extremely busy with extracurriculars. I will be posting more since the weather is poor. Here they come...

A Pharmacist's Day Depends On If They Get Their Coffee

When a pharmacist doesn't get their daily morning fix of coffee it's usually a bad sign of how the rest of their day is going to go.

Not only did I not get my morning coffee the other day, but I got a whole lot more than I was asking for.

The other day, I woke up a bit late. Not really a big deal, this just meant I would have to skip my morning excursion to get my coffee at the usual place. I could just stop at the Starbucks across from where I work since it was my way, despite the fact that I try to support my local independent businesses at least I would get my morning fix. As I park and walk in to the coffee giant and get into the unusually long line, I begin to debate whether the wait will be worth it. Remembering that it was the first of the month, I figured that the wait was a small price to pay for the sake of my sanity or at least what I could salvage of it. As I go to the front of the line to place my order the barista said to me, "How can I help you?" I responded that I would like a hot vanilla latte (especially since it has been cold in the late fall mornings here). "I'm sorry but we can't make hot drinks because our machine is broke."

This should have been a sign of how my bad was going to go.

Rather than get something I wasn't in the mood for I said that's OK and left. Figured I might as well make it in a little bit early and try to get ahead as much as I could. In retail pharmacy you can never truly get ahead because all it takes is a couple of problems and next thing you know you are backed up horribly. I went about work as normal and opened the store with a few patients already waiting to pick up their medication. Several more people came and next thing I knew it was 9:30 before my first technician came in. She was scheduled for 9:00, therefore causing me to start out my day a little behind because I had less time to catch up on things like physician calls and other pharmacist tasks.

I head back to work on my pharmacist tasks and realize as I am working my way through the prescriptions that are in the Trouble queue, that may partner (who is the pharmacy manager) had put off solving most of the previous days problems and they had fallen on me. It took over 2 hours to solve almost all of these problems, while making phone calls and filling prescriptions at the same time. The phone ringing off of the hook did not help any as I only had one technician until 11:00, thus forcing the other technician to deal with people while I played pharmacy secretary, filling tech, and pharmacist.

By the time 11:00 did roll around and the second tech came in, I was pretty backed up. She got to work and helped shorten my wait time back down to a normal wait time. Then I got a phone call that would put my work day into a perpetual state of being behind. "Hi, I am calling from another pharmacy and have 18 prescriptions to transfer to you, should I just save us both a huge headache and fax them?"

CRAP!

I agreed faxing would be easier and less time consuming for us and told the other pharmacist to fax them over. After a few minutes they came through filling up my printer. I walked them down to the prescription drop off window and put them there for a tech to scan in when they had time. Thank God, this was not an urgent matter but one that had to be done eventually anyways.

My third technician came in around 12:00, as is usual, and helped us get fully caught up. We still had quite a bit of patients coming in and getting prescription but luckily for me they had the foresight to call them in the day before or earlier in the day. Sometime around 1:00 it got really quiet for about 15 minutes. We still had some things to do but no people came in or called to interrupt or activities. Just as the saying goes, it's always quiet before the storm.

I just didn't know that this applied to hurricanes too.

Right about 1:30, ironically the same time the bus stops in front of my pharmacy, we had a swarm of people come in, all with at least 3-4 prescriptions. This combined with their entitlement attitude (which is common among Medicaid patients), lack of patience and other patients using the drive thru, we became extremely backed up. My usually respectable wait times turned into 1 hour and 1 1/2 hour wait times. This lead people to become short-fused with me and start to yell, "All you have to do is throw it in the bottle and in the bag, what takes an hour and half?" I have a slight problem with this sort of attitude towards pharmacies, so I am always glad to explain that we do more than that and unlike McDonalds we don't just throw it in the bag and hope it's the right order. This trend continued for a few hours, leading to quite a few headaches and backups in the pharmacy.

While dealing with this huge influx of new prescriptions, now we had to do everything we could to get them out of them pharmacy. This may sound simple, but never is. Many of these patients had issues with their insurances. Lots of prior authorizations, a few drug interactions that required calls to physician offices, old prescriptions that were out of refills thus requiring faxes to physician offices and a few prescriptions that were cancelled once a chart review realized that the patient was an abuser. Again, pharmacies do not operate on the same level as McDonalds with a guy in a white coat behind the counter. Pharmacists and the techs do tons to make sure medication is dispensed safely in a manner that patients can benefit from it and make sure the medication gets to the correct people. All of this in a relatively short amount of time considering one mix up or person being lazy can cause serious issues in health for a person.

Then came the phone calls.

While working on the multitude of prescriptions that were brought in, I noticed my voicemail had rang several times. When I saw a break in the action, I checked it (yes I did check it earlier in the day a few times as well). "There are 13 messages"

CRAP!

It took me around 20 minutes to transcribe all of the messages that had been called and get them ready to be scanned into the system. Now my wait time was at almost 2 hours. I thought to myself most district managers would scream blasphemy at me if I told them this wait time. Then my district manager stopped in and made the mistake of asking how everything was going. I am not sure whether it was when I asked if he wanted to wait on people, fill prescriptions, answer the phone or start to type prescriptions but something made him leave pretty quickly.

The phone still kept ringing. Finally a lot of the physician offices were calling back on the earlier prescriptions. Several irate customers also decided to call, just to mix things up for me . One patient called with the opening line that will give any pharmacist chills, "You filled my prescription wrong!" After addressing the patient and looking into the prescription was actually filled correctly. This conversation took way too long to explain to the patient since apparently the physician decided to change the prescription from when he had talked to the patient to when he sent it over electronically, especially since the prescription was adjusted due to the patients poor kidney function. The patient then went into a tirade about how I am always right and am not listening to them. I was in no mood now to listen to somebody, who I had just fully explained why the prescription was right and that I even called their physician over the odd dose and had it clarified, and reinforced what I had done for the patient to ensure it was correct. The patient kept explaining how the whole thing was wrong and would not let up. I kept re-explaining myself until I finally told the patient there was nothing more I could do for them and that if they had nothing else I was getting off the phone. It always amazes me how many people don't actually trust medical professionals despite our best efforts to be transparent and explain things to them.

All of these problems finally starting subsiding around 7:30 PM. That's when apparently the store management decided that since it was the first of the month and the pharmacy didn't have a long line they would send store customers to the pharmacy to be rung out with their full shopping carts. My techs and I tried to explain, while on working on prescriptions, that we only ring out 5 items or less. Two customers did not want to hear this, so they decided to embark on a four letter laden tirade because they had to wait in line like everybody else in the front of the store. Some people just feel they should always be the exception, I guess.

The first of the month brings out the best in people. It makes for an extremely busy day in the pharmacy, especially if you are in a low income area like myself. This was a quick synopsis (yes I left many things out that added a great deal of other smaller issues) of my work day the other day. Some people, even other pharmacists view retail pharmacy as being an easy job. They do not realize the many things that we actually do for our patients and put up with from others. Retail pharmacy is what I like to call the front lines of health care. We see and deal with many things that people and other health care providers do not have to. Without retail pharmacists where would patients get their medication and how would a patient on several medications and seeing several physicians be assured that they are getting their medication safely? Retail pharmacists are essential and perform a critical job, including dealing with irate patients.

Next time you are in a local pharmacy be sure to say hello to the pharmacist and if you feel the urge let them and the techs know they are appreciated. This is the one thing that puts a highlight in their day, despite all of the grief they deal with. Heck, maybe get them a gift card to their favorite coffee place so a few of their days can start off well, trust me they will make sure you are taken care of for then on out!

When A Medical Professional Turns Into The Patient...

I woke up the other morning with pretty badly irritated eye. Apparently I forgot to take my contacts out before going to bed. WHOOPS! I walked into the bathroom and looked into the mirror just to see how seriously red my eye was. I decided to take my contacts out, not sure whether it would make the situation worse or not. It made it worse, much worse! My eyes had a sharp stabbing pain whether it was open or shut. I continued to cover and wipe my eyes of drainage and decided to lay down and see if it passed. This did not help very much so I got the idea to put some contact solution into my eye in hopes it would bring some relief. It only stung more.

I guess I had to go to the pharmacy to see if something like Clear eyes or Visine would help. I figured that if this didn't do the trick, I might have to get some further medical attention that was above my own skill as a pharmacist.

The pharmacy I went to was the one I currently work at. I called a friend and he went with me in case my eye really bugged me. I made it to the pharmacy, picked out the eye drops I had in mind and left. My friend drove me home and stuck around to make sure I was alright. Thank God for good friends. The eye drops burned and did not seem to help much. I waited awhile and tried them again still to no avail. It was time to seek further care.

My friend drove me to an Urgicare which I used to know some nurses at. When we got there I had to fill out 4 forms and give them my insurance and identification. Filling out forms with one hand over your eye is not the most fun, especially after a 20 minute car ride which simply looking out the window makes you nauseated. I turn in the forms and waited to be seen. I waited about an hour and fifteen minutes in the waiting room before being called back to an exam room. Finally!

Once in the exam room the nurses came and asked some basic history and pain questions. They also took my blood pressure and they took it wrong. They raised my arm just over shoulder height and took it. Blood pressure readings should be done at heart level, at least that's what they taught me. I then continued to wait 45 minutes for the physicians to come into the room. He explained what he thought it was (since I gave a very detailed explanation he probably could have diagnosed it without even seeing me) and what he was going to do to examine it. Overall, he was very professional and I was pleased with his work. He then explained he did not see anything serious but was going to give me and antibiotic just to be safe. I then told him I was a pharmacist and wondered what he was thinking for an antibiotic. He said I should have mentioned it earlier and said he was going to write for Vigamox.

Wrong answer.

I knew Vigamox is over $100 a bottle and requires a prior authorization for every insurance I have every dealt with including my own. I suggested tobramycin and explained to him what I knew. He agreed and appreciated my knowledge then left to write the prescription. He came back and gave me follow up instructions if needed, including an ophthalmologist he knew personally, as well as the prescription for tobramycin eye drops, then showed me out to the nursing staff to sign one more item.

When I saw the nurses and signed their document, I asked them to call my prescription into a pharmacy near by that was part of the chain I work for. They were hesitant and said they do not do that.

Wrong asnwer.

I told them I am a pharmacist and that I knew the pharmacist they would be calling it into. They checked with the physician who literally said, "Ya, why wouldn't we call it in?" They agreed and I left with my friend to go to the pharmacy.

We got to the pharmacy 30 minutes prior to close and to no surprise my prescription was not ready. I asked how long and the intern, who I knew, said that the pharmacist did not take it because they were out of stock of it. Personally, I would have still taken it and then offered the patient to transfer it, but to each their own. The pharmacist said the Urgicare was going to call me to call another pharmacy with it or to preferably to pick it up. One problem, my cell phone was dead. Thankfully, my friend let me use his phone to call the Urgicare and call it into the exact pharmacy I work at, to which the Urgicare nurse obliged.

We drove to my pharmacy, speeding a little since we know we would be getting there with in 5 minutes of closing. I called ahead as we pulled off the highway and my pharmacist partner said it was ready and he would stay open until I got there and that he rushed it since he knew it was mine. Again, I am thankful I know how the medical system works and some people in it, which allowed me to get my prescription in a fairly timely manner.

As I was rung out by my cashier, I thought to myself, "What if I wasn't a pharmacist?" This would have meant that the doctor would have written for an expensive prescription which my insurance wouldn't have covered. I would have gotten to the first pharmacy and been pretty frustrated since I had spent 2 hours plus at the Urgicare and still had a sore eye. If the pharmacist would have called the Urgicare to change the prescription, she would than have not had the antibiotic in stock. I then would have to go to another pharmacy to get my prescription. I also would not even be able to stay with the same chain to get my prescription that night since they all would have been closed. I may have even not gotten my prescription that night. On top of all of this the antibiotic I did receive needs to be applied every 3 hours while awake. This is fine by me, since it was $4 instead of over $100, but even as a medical professional applying an eye drop every 3 hours is hard to remember. Imagine if I were a patient again, I would probably be annoyed and not understand why the drop needs to be used so often.

This whole experience really did make me think differently about patients who come in last minute. Ironically enough I had a patient about my age come in with an antibiotic 5 minutes prior to close while I was already busy the night prior to my eye injury. I told him to stick around as I would make sure he got it before he left. The man was grateful for my services and that I took care of him despite being busy. I now fully appreciate his appreciation for me taking care of him despite the fact that I was closing really soon. Thankfully, karma must have paid off and taken care of me when I needed it. I can definitely say I look at the last minute patient with a little bit more respect considering what they might have just been through. If a last minute patient just hurried to make it in, I will definitely take care of them as long as they are in a true urgent need and not just filling a prescription they had for 2 weeks. This is especially true if a patient has an antibiotic or is from an Urgicare!

Pain Management For Sale

This picture was sent to me by a reader. This scares me. This is what is wrong on so many levels. If I had seen this, I think I might have stolen it to help fight abuse.

Why Herbals Are So Popular

"Is there anything over the counter I can take for my menopause?"

"Where's your glucosamine at?"

"Can you recommend something natural?"

These are some very common phrases around most retail pharmacies these days. Many consumers are turning to herbal supplements to help them improve their health or to aid them in other ways. This boom in herbal remedies is due in large part to the amount of information available on the internet and the ease of access it provides now more than ever.

On a daily basis I have handfuls of patients that ask me question pertaining to a variety of health issues and remedies for them that they have researched on the internet. In many cases, these patients come to me asking what I think about specific products and "do they work" or "how well do they work". With the availability of information many of my patients can filter out their symptoms and essentially find their "diagnosis". I use that word loosely since only limited medical professionals can actually make a diagnosis.

To be fair to lay people, I put myself in their shoes...

I am sitting at home with knee pain and wondering what I should take? Should I take the Celebrex (celecoxib) the physician prescribed for me? I just saw a commercial of which half it was the risk of side effects including possible heart issues (by law 1/2 of all prescriptions advertising must be focused on things such as side effects, just look at the next printed medication ad you see in a magazine). Well that seems a little bit serious. I remember there was a commercial for Osteo-Bi-Flex when I was watching the price is right and it didn't list any side effects. No side effects must mean that it's safer, right? There was also a commercial for One-A-Day Energy which said it would give me that little kick I needed. I am going to go the the drug store...

After arriving at the drug store, I grab a generic pain reliever (that is similar to Celebrex but cheaper as my pharmacist said) and what appears to be a generic for Osteo-Bi-Flex. I look at the labels...

First the herbal supplement...

Just like I thought, there aren't very many warnings. Now let's look at the over the counter (OTC) pain reliever...

WHOA!! That's a lot of information on a bottle about the same size. I think I am going to try the herbal instead. Let's look at the energy vitamin. It looks like the rest except it has guarana with an asterisk by it. It's probably alright...

Now this is in now way an all encompassing example. Many of my patients will actually listen to what I recommend for them, especially if I tell them it's what I would take if I were them. However, there are also several patients a day that now matter what I say they believe that the natural is better. I do what I can to help all but sometimes, they will not simply listen.

With such strong FDA restrictions on prescription and some OTC medications while have little to no regulation over herbals it is no wonder why advertising and the billion dollar herbal industry has lead consumers to think they are much safer than FDA tested and regulated medications. Many patients, even when they look up herbals on the internet, are not aware of the side effects or drug interactions of many herbal medications or that many of the herbal products are not tested and in many cases are not regulated for quality.

Just to highlight a few common areas I see in a daily basis I will keep this herbal review short. VERY SHORT. Here are some herbal basics:

1. ALWAYS consult a pharmacist/physician before taking them. At the very least do some homework and look up possible indications and directions for use as well as potential side effects.

General Rule: Beware of the G's - Ginseng, Guarana, and Garlic. These have the most interactions and the first two can increase blood pressure signigicantly. Glucosamine is generally safe but may interact with Coumadin (warfarin)

2. If it makes some cure all or miraculous claim, it's garbage and will not live up to the hype

This includes: most weight loss remedies (Alli will work but with proper diet and exercise only minimally), male enhancement or erectile dysfunction (ED) herbals (some with yohimbe or horny goat weed may work but all of them I have seen have ingredients that will raise blood pressure which may worsen ED), and colon cleansing products to name a few.

3. A lot of the herbals have some basis as to why they work. However, many may only work mildly if at all. They are not replacements for prescription medications.

4. Look for the USP or ISO certification stamps. These mean these herbals where tested by an independent third party and actually have what they claim in them. Thus these are safer than most.

5. Do not ask advice at a store that strictly sells these products. Many of the employees have numbers they need to reach and will sell you a variety of things to meet THEIR NEEDS, not yours. Instead ask a health care provider, like a pharmacist. We must be able to legally back up what we recommend. Would you trust someone who must back up their recommendation in a court of law or someone who was hired last week and is still in high school?

With all of that being said herbals are not always a bad thing and can actually help many people live better lives. They are not cure alls but should be used with the same discretion as prescription medications. Everything has side effects even foods. If a person eats too much fat, they gain weight. BOOM! Side effect! Always ask advice of a professional. Yes, they may make a little bit off of selling you something but they are held accountable for what they tell you. That's why they are PROFESSIONALS!

15 Pharmacy Rules for Patients

Pharmacy Rule #1: If your name looks like a set of Scrabbles tiles don't yell at me if I butcher it.

Pharmacy Rule #2: I can only explain your insurance only covers 30 days worth of medication instead of 90 in so many ways before I give up. I am not bad at dumbing things down, you may just not be that intelligent.

Pharmacy Rule #3: If you don't know the date of birth or address for the prescription you are picking up, I do not know how to sell it to you. Double checks are there for a reason.

Pharmacy Rule #4: If I tell you your refill is too soon and you try to have it transferred to a different pharmacy, I will make sure the other pharmacist knows it's too soon and that you are a current problem for me. Therefore they won't fill it either.

Pharmacy Rule #5: If you try to get you pain medication filled too early repeatedly you will get a nice note in your profile that will let other pharmacists know this.

Pharmacy Rule #6: Respect. Respect the pharmacist and the technicians. Respect is mutual and if you don't respect us, we will not respect you.

Pharmacy Rule #7: If you do not think something is correct please feel free to ask. If you do I will look into it and try to correct and problem willingly. If you yell and make a scene, I probably will not go out of my way (unless it's truly bad).

Pharmacy Rule #8: If you simply say thanks or show that you appreciate my work, I will bust my hump for your gratitude and take care of you.

Pharmacy Rule #9: If I can't read it, I can't fill it. I will try to clarify any issue, unless you act indignant towards the fact that my effort and care may take a few more minutes to ensure YOU get what YOU need.

Pharmacy Rule #10: Your physician isn't always right. Neither am I and neither are you. Everyone's human, so there is no reason to go crazy about something if it's small. If it's big bring to my attention as politely as possible and it WILL be resolved.

Pharmacy Rule #11: Controlled medications are controlled for a reason. This is why I can not fill them early. Drug abuse is real and very serious. No early controls. Period.

Pharmacy Rule #12: I see more patients than any other medical professional and do it fast and accurate. If I need extra time to ensure something is correct, please allow it. It is YOUR health.

Pharmacy Rule #13: If you think my hold time sucks, feel free to call your own insurance company. I do it all the time for YOUR gain, not mine. Trust me it sucks 5 times worse.

Pharmacy Rule #14: There are many pharmacies and pharmacists out there. If you and I don't get along or see eye to eye, feel free to venture elsewhere for BOTH of our sanities.

Pharmacy Rule #15: I became a pharmacist to help people. I did not go through 6 years or more of college, stay up countless hours studying and busting my hump to be a pain in your side or to play God as some may accuse me of. I use knowledge, legalities and logic to ensure what I am doing is the best for my patients and others. This is why I am a pharmacist.

That is all of my pharmacy rules for patients.

Until I can think of more.